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HomeMy WebLinkAboutMiscellaneous - 386 CHESTNUT STREET 4/30/2018 (2)LaMarche Associates 5 North Road, P.O. Box 250 Chelmsford, MA 01824 800-349-1525 Fax: 978-256-8590 April 13, 2015 Building Commissioner/Inspector of Buildings NORTH ANDOVER, MA 01845 Board of Health/Board of Selectmen NORTH ANDOVER, MA 01845 NOTICE OF CASUALTY LOSS TO BUILDING UNDER MASSACHUSETTS GENERAL LAWS, CHAPTER 139, SECTION 3B Claim has been made involving loss, damage or destruction of the property captioned below, which may either exceed $1,000.00 or cause Massachusetts General Laws, Chapter 143, Section 6 to be applicable. If any notice under Massachusetts General Laws, Chapter 139, Section 3B is appropriate, please direct it to the attention of the writer and include a reference to the captioned insured, location, policy number, date of loss, cause of loss and LA file number. Insured: STEVEN & ELAINE TRYDER Loss Location: 386 CHESTNUT ST. NORTH ANDOVER, MA 01845 Policy Number: PH00100806407 Date of Loss: 02/28/2015 Cause of Loss: Water LA File Number: MA -2-28732 On this date, I caused copies of this notice to be sent to the persons named above at the addresses indicated above by first class mail. Kevin Charlton Adjuster LaMarche Associates, Inc. - 800.349-1525 Page 1 of 1 1 p 4 Location No. Date�- NORTH 1ti� TOWN OF NORTH ANDOVER 3?O�,to 0 F w Certificate Occupancy ; } of $ ° s�cMust Building/Frame /Frame Permit Fee $ 9 ;_ Foundation .Permit Fee $ t Other Permit Fe, $ TOTAL $ w Check 16735 //1 Building Inspector ,J TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING - BUILDING PERMIT NUMBER: DATE ISSUED: SIGNATURE: Building Commissioner/I or of Buildings Date • SECTION 1 -SITE INFORMATION 1.1 Property Address: Historic District: Yes NO 1.2 Assessors Map and Parcel Map Number Number: Parcel Number 2.2 Owner of Record: +Name Print Address for Service: 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Areas Frontage ft 1.6 BUILDING SETBACKS 00 Not Applicable Front Yard Side Yard 3.2 Registered Home Improvement Contractor Rear Yard Required Provide Required Provided R red Provided Address Expiration Date Signature Telephone 1.7 Water Supply M.GL.C.40. 34) Public ❑ Private ❑ 1.5. Flood Zone Infomntion: Zone Outside Flood Zone ❑ 1.8 Municipal Sewerage Disposal System: ❑ On Site Disposal System ❑ SEC TION 2- PROPERTY OWNERSHIP/AUTHORIZEDAGENT Historic District: Yes NO 2i1 Owner of Record i Xc uifjv 7Ay415-4 3P�6 c% S MWT S1 Name (P ' t) Address for Service: - 6s'- zZ ignatu Telephone 2.2 Owner of Record: +Name Print Address for Service: Signature Telephone SEZ;TION 3 - CONSTRUCTION SERVICES 3.1. Licensed Construction Supervisor: Licensed Construction Supervisor: Address Signature Telephone Not Applicable License Number Expiration Date 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Signature Telephone OU M X z O M O z M 90 O s r M r r z 0 SECTION 4 - WORKERS COMPENSATION (M.G.L C 152 S 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building it. Signed affidavit Attached Yes .......❑ No ....... ❑ SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) r Q ' Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: E'-! T C 91 W Kr--%, kF:7- �1ts16�1 w rl�J� SX2RLDz Fv-WAJA-,(-,r SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost to (Dollar)be" Completed by permit applicant IIFIC �USE i�Y s 1. Buildingfir/ v� d r (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) x (b) 4 Mechanical I4VAC 5 Fire Protection 6 Total -(1+2+3+ +5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner/Authorized Agent of subject property ereby authorize );WN C rz .D r4/(Z1 LV to act on behal all matters a to work authorized by this building permit application. Si tore of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, as Owner/Authorized Agent of subject Property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief Print Name Signature of Owner/A ent NO. OF STORIES Date SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 2No 3RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE V 3 Tel: 978-68&9545 HOMEOWNER LICENSE EXEMPTION Please print. DATE JOB LOCATION__ CA4�riyU% S l E T :.Number ' J Street Address Q Section "HOMEOWNER _x / 6 �-I it/ v 7 31-! G� S —ZZ1 / Number Home Phone Work PRESENT MAILING AD City Town of State Zip C, The current exemption for "homeowners" was extended to include owner -occupied dwellings of six units or less and to allow such homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. (State Building Code Section 109.1.1) DEFINITION OF HOMEWOWNER: Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one to six family dwelling, attached or detached structures ac- cessory to such use and and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner" shall submit to the Building Official, a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned "homeowner" assumes responsibility for compliance with the State Building Code and other Applicable codes, by-laws, rules and regulations, The undersigned "homeowner" certifies that he/she understands the Town of No. Andover Building Department minimum inspection pr edures and requirements and that he/she will comply with said procedures and require nts. HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL Note: Three family dwelling 35,000 cubic feet, or larger, will be required to comply with State.Building Code Section 127.0 Construction Control. f NORTi. r60�t� Ybf Town of North Andover d 1 - Building Department 27 Charles Street "SSa�H„SEt North Andover MA 01845 HOMEOWNER LICENSE EXEMPTION Please print. DATE JOB LOCATION__ CA4�riyU% S l E T :.Number ' J Street Address Q Section "HOMEOWNER _x / 6 �-I it/ v 7 31-! G� S —ZZ1 / Number Home Phone Work PRESENT MAILING AD City Town of State Zip C, The current exemption for "homeowners" was extended to include owner -occupied dwellings of six units or less and to allow such homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. (State Building Code Section 109.1.1) DEFINITION OF HOMEWOWNER: Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one to six family dwelling, attached or detached structures ac- cessory to such use and and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner" shall submit to the Building Official, a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned "homeowner" assumes responsibility for compliance with the State Building Code and other Applicable codes, by-laws, rules and regulations, The undersigned "homeowner" certifies that he/she understands the Town of No. Andover Building Department minimum inspection pr edures and requirements and that he/she will comply with said procedures and require nts. HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL Note: Three family dwelling 35,000 cubic feet, or larger, will be required to comply with State.Building Code Section 127.0 Construction Control. yvv m m Cl) cn0 m Q C � y n n Z H co o -v CL C' � � c d � H o C -J O v CD CDCL o Q d o Er o CD cow a s CD y CD CO y CO � CD C2 CA O 'OCD Z ,nom, CD O O W G O MA C �,o O d S O ti co n m C) CO) CDdC =rflN CD did O m '♦O O N0 CO) O . ►� G; C, _ .r O Z�•Cf O N C2 - O O =r = 'Mo a v' CDCL ra o ? s' O O N CL m N . CL ELW- �<= CD N CIOCD O w CO .Ort CO CD o� 4s cl,o � O . CD CD CD: I ?m a� ;w N W ID ^. oCD: dm: nn: !C,! C O �w O N 0 I L C OM P Cf ^n � n W O w 7 mw p y Te p Ci9 m Q iOy Z � w O tic O n. CD x 0 I L C OM P ,i Date....!P" NORT„ TOWN OF NORTH ANDOVER p PERMIT FOR WIRING SSACNUSE� This certifies that .............'r v4 j( has permission to perform t V. i C ....... .....t'e l©C �"� � C) ^> ......................................... wiring in the building of ... CJ v'� � rtq &e .............................................................. , 35...............................................................C Q S . North Andover, Mass. .....w Fee... J ..... Lic.No3.........I .°.b.. .................. ELECTRICAL INSPECTOR Check # 5251 1\ tx Of 4P ilgom iIIItli ralt4 of Massar4ulle li Office Use Only Department of Public Safety > Permit No. BOARD OF FIRE PREVENTION REGULATIONS -27 CMR 12:00 Occupancy & Fee Checked 3/90 (leave blank) APPLICATION FOR PERMIT To PERFORM ELECTRICAL WORK All work to be performed in acoprdance with th Massachusetts Electrical Code, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) City or Town of { 1/ y r 113 /-7 The undersigned applies for a permit to perform the Location (Street & Number) : V rn ct Owner or Tenant 6IC- oe- -tl Owner's Address Date To the Inspector of Wires: Is this permit in conjunction /�with a building permit: Yes LJ No M (Check Appropriate Box) Purpose of Building �f?Q_ 1, Utility Authorization No. �Y7 6 1 Existing Service GL— Amps ,L1 Iy Volts Overhead IJ Undgrd ❑ No. of Meters New Service fJt7 Amps 1ik/ / Volts Overhead Wundgrd ❑ No. of Meters �Z Number of Feeders and Ampacity 1!iAmg — p C)d Location and Nature of Proposed Electrical Work Gt�or e. '��.✓ i/J h°_ lOf, r)e^ OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusttes General Laws have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES ❑ NO ❑ ! have submitted valid proof of same to this office. YES ❑ NO ❑ If you have checke YES, please indicate the type of coverage by checking the appropriate box. INSURANCE E BOND ❑ OTHER❑ (Please Specify) Estimated Value of Electrical Work $ �TQ Work to Start . r+ e d1_0 "L/ Inspection Date Requested: Rough Signed under the penalties of perjury: Final (Expiration Date) F�RM NAME LIC. NO. ,Licensee y� Signature LIC. NO. Address �_�/ dA_ T�'dyt lJ� I ✓L h. 14YZ2 A 2 ZeF/ y Bus. Tel. No. ? >P,?627 ?, Alt. Tel. No. .OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as required by Massachusetts .General Laws, and that my signature on this permit application waives this requirement., Owner Agent (Please check one) Telephone No. PERMIT FEE $ (Signature of Owner or Agent) TOTAL No. of Lighting Outlets No. of Hot Tubs No. of Transformers KVA AboveIn- [:]rnd. ❑ No. of Lighting Fixtures SwimmingPool rnd. Generators KVA No. of Emergency Lighting No. of Receptacle Outlets No. of Oil Burners Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Detection and Total No. of Ranges No. of Air Conditioners Tons Initiating Devices No. of Sounding Devices. Heat Tota Tota No. of Disposals No. of Pumps Tons KW No. of Self Contained Detection/Sounding Devices. No. of Dishwashers Space/Area Heating KW Municipal Local[],Connection ❑Other No. of Dryers Heating Devices KW No. o No. ot Low Voltage No. of Water Heaters KW Signs Ballasts Wiring No. Hydro Massage Tubs No. of Motors Total HP OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusttes General Laws have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES ❑ NO ❑ ! have submitted valid proof of same to this office. YES ❑ NO ❑ If you have checke YES, please indicate the type of coverage by checking the appropriate box. INSURANCE E BOND ❑ OTHER❑ (Please Specify) Estimated Value of Electrical Work $ �TQ Work to Start . r+ e d1_0 "L/ Inspection Date Requested: Rough Signed under the penalties of perjury: Final (Expiration Date) F�RM NAME LIC. NO. ,Licensee y� Signature LIC. NO. Address �_�/ dA_ T�'dyt lJ� I ✓L h. 14YZ2 A 2 ZeF/ y Bus. Tel. No. ? >P,?627 ?, Alt. Tel. No. .OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as required by Massachusetts .General Laws, and that my signature on this permit application waives this requirement., Owner Agent (Please check one) Telephone No. PERMIT FEE $ (Signature of Owner or Agent) I Date l .. ....... HORTh o TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING ,SSACHU (2, This certifies that ................................................................................... has permission to perform ....: ....................... wiring in the building of .................................................. . ............. ..................................e- ............ . North Andover, Mass. Fee.....`....''...... Lic. No .............. ...... ...... '�9LECrRICAL INSPECTOR Check # 4607 I ti e (Enmmunwea #p of Aussur4ugetto Office Use Only Department uf' Public Safety V�� Permit iVo.. •, ��� BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 7 Occupar.r.y & Fee Checked 3,90 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 12:00 I (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) City or Town of N0. ANDOVER The undersigned applies fora permit to perform the electrical work described below. Location (Street & Numher) 386 Chestnut Street Owner odd Steven To the Inspector of Wires: Owner's Address Is this permit in conjunction with a building permit: Yes No ❑ (Check Appropriate Box) Purpose of Building Existing Service New Service Amps /_ Volts Amps /. Volts Utility Authorization No. __ Overhead ❑ Undgrd ❑ Overhead ❑ Undgrd ❑ No. of Meters No. of Meters Number of Feeders and Ampacity Changing of system from zone valves tn ri r it atnr Location and Nature of Proposed Electrical Work Wiring for new circulators No. of Li8hting Outlets No. of Hot Tubs TOTAL No. of Transformers KVA No. of Lighting Fixtures Above Swimming Pool grnd. ❑ rnd. ❑ Generators KVA No. of Receptacle Outlets No. of Emergency Lighting No. of Oil Burners Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Detection and Initiating Devices No. of Ranges Total No. of Air Conditioners Tons Heat oto Tota No. of Disposals No. of Pumps Tons KW No. of SoundingDevices. No. of Self Contained No. of DishwashersDetection/Sounding S ace/Area Heatin KW Devices Municipal ❑ ❑ No. of DryersLocal Heatin Devices KW Connection Other No. of Water Heaters KW No. o No. of signs Ballasts Low Vo Cage Wiring No. Hydro Massage Tubs No of Motors Total HP OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusttes General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YEMX NO ❑ I have submitted valid proof of same to this office. YES X10 0 If you have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE 191 BOND ❑ OTHER❑ (Please Specify) National Grange Mutual Iris. Co.-_ 3-11-04 Estimated Value of Electrical Work $ (Expiration Date) Work to Start nspection Date Requested. Rough _ Final Signed under the penalties of perjury: FIRM NAME Laroche Electrical, Inc. % LIC. NO. Licensee Arthur W. Laroche, Jr. Signature ! LIC. NO. MR 13 Address 9 Windchime Dr-, Bow, NH 03304 Bus. Tel. No. 603-898-2407 s Alt. Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have [he insurance coverage or its substantial equivalent as required by Massachusetts General Laws, and that lily signature on this permit application waives this requirement. Owner Agent (Please check one) Zhie Commonwealth of Massachusetts w d De artment qfPubfic Safety t Board o Building Regulations and Standards M SJ One Ashburton Place, Room 13 qomas G. G atzunis, Boston M��VE�P.E. MitRomney t Commissioner Governor Stanley Shuman Phone (617) 727 JUL 7532 2 5 2005 Kerry Healey tJle Chairman Lieutenant Governor Fax (617) 227-1754 Gary Moccia u Edward A. Flynn BUILDING DEPT. Vice Chairman Secretary Thomas L. Rogers Administrator Certified Mail 7003 2260 0003 65311117 July 19, 2005 Kenneth Duval Duval Roofing P.O. Box 637 N. Reading, MA 01864 COMPLAINANT: Dear Mr. Duval: Case H2O05-230 Steven Tryder 386 Chestnut St. N. Andover, MA 01845 Note: Rescheduled RE: NOTIFICATION OF ADMINISTRATIVE HEARING FOR HOME IMPROVEMENT REGISTRATION # 109288 Pursuant to 780 CMR R6 the Department of Public Safety/Board of Building Regulations and Standards will hold a hearing in accordance with 801 CMR 1.02 to determine whether administrative action will be taken on the status of Home Improvement Contractor Registration # 109288 issued to you. The hearing will address the following allegations: Alleged Violations, Chapter 142A, Section 17, items, 2, 4, 8,10,16,17 Abandoning or failing to perform, without justification, any contract or project engaged in or undertaken by a registered contractor or subcontractor, or deviating from or disregarding plans or specifications in any material respect without the consent of the owner, Making any material misrepresentation in the procurement of a contract of making any false promise of a character likely to influence, persuade or induce the procurement of a contract, Publishing, directly or indirectly, any advertisement relating to home construction or home improvements which does not contain the contractor's or subcontractor's certificate of registration number or which does contain an assertion, representation or statement of fact.which is false, deceptive, or misleading. Violation of the building laws of the commonwealth or of any political subdivision thereof; Demanding or receiving payment in violation of clause(6) of paragraph(a) of section two which states: "a time schedule of payments to be made under said contract and the amount of each payment stated in dollars, including all finance charges. Any deposit required under the contract to be paid in advance of the commencement of work under said contract shall not exceed the greater of one-third of the total contract price or the actual cost of any materials or equipment of a special order or custom made nature, which must be ordered in advance of the commencement of work, in order to assure that the project will proceed on schedule. No final payment shall be demanded until the contract is completed to the satisfaction of the parties thereto; Violating any other provision of chapter 142A. Please note the following DATE/TIME/PLACE OF YOUR HEARING: Date: Tuesday, August 16, 2005. Time: 12:30 PM Place: Department of Public Safety McCormick Building One Ashburton Place, Room 1301 Boston, MA 02108 Substantiated violations as determined by the hearing officer may result in suspension or revocation of this registration and/or assessment of an administrative penalty up to $2,000 for each violation. You have the right to be represented by legal counsel at this hearing and present oral testimony and documentary evidence on your behalf. Request for continuances of any scheduled hearing must be made, in writing, and received in this office no later than ten (10) days prior to the scheduled hearing.. The request for must include detail reasons for the requested continuance. The matter shall not be deemed continued unless you have received notice from this office granting the continuance. A complete investigatory file is available for review at the Department Public Safety during regular business hours. Failure to appear for this Hearing without approved reason may be cause for immediate suspension or revocation of your Home Improvement Registration and may also result in monetary penalties. Please address any correspondence concerning this matter to the following: Estee Ormont, Program Coordinator Department of Public Safety/BBRS Home Improvement Contractor Registration Program One Ashburton Place, Room 1301 Boston, MA 02108 (617) 727-3200 extension 25225 Very truly yours, Estee Ormont Hearing Clerk Cc: Steven Tryder, Complainant :� Robert Nicetta, Inspector of Buildings, N. Andover r 11he Commonwealth of Massachusetts d Department of Pubtic Safety Board o Building Regulations and Standards �,M S�•y One Ashburton Blase, Room 1301 Thomas G. G atzunis, Boston P E Mitt Romney tCommissioner Governor Pfw1w (617) 727 7532 Stanley Shuman Chairman Lieutenant Governor Kerry Healey , fax (61 7) 22 7-1754 Gary Moccia Vice Chairman Edward A. Flynn Secretary Thomas L. Rogers Administrator Certified Mail 70001670 00015768 7672 July 18, 2005 Kenneth Duval Duval Roofing P.O. Box 637 N. Reading, MA 01864 COMPLAINANT: Dear Mr. Duval: Case H2O05-230 Steven Tryder 386 Chestnut St. N. Andover, MA 01845 DECEIVED JUL 21 2005 BUILDING DEPT. RE:. NOTIFICATION OF ADMINISTRATIVE HEARING FOR HOME " IMPROVEMENT REGISTRATION # 109288 Pursuant to 780 CMR R6 the Department of Public Safety/Board of Building Regulations and Standards will hold a hearing in accordance with 801 CMR 1.02 to determine whether administrative action will be taken on the status of Home Improvement Contractor Registration #109288 issued to you. The hearing will address the following allegations: Alleged Violations, Chapter 142A, Section 17, items, 2, 4, 8,10,16,17 Abandoning or failing to perform, without justification, any contract or project engaged in or undertaken by a registered contractor or subcontractor, or deviating from or disregarding plans or specifications in any material respect without the consent of the owner; Making any material misrepresentation in the procurement of a contract of making any false promise of a character likely to influence, persuade or induce the procurement of a contract; Publishing, directly or indirectly, any advertisement relating. to-, home construction or home improvements which does not contain the contractor's or subcontractor's certificate of registration number or which does contain an assertion, representation or statement of fact which is false, deceptive, or misleading. Violation of the building laws of the commonwealth or of any political subdivision thereof; Demanding or receiving payment in violation of clause(6) of paragraph(a) of section two which states: "a time schedule of payments to be made under said contract and the amount of each payment stated in dollars, including all finance charges. Any deposit required under the contract to be paid in advance of the commencement of work under said contract shall not exceed the greater of one-third of the total contract price or the actual cost of any materials or equipment of a special order or custom made nature, which must be ordered in advance of the commencement of work, in order to assure that the project will proceed on schedule. No final payment shall be demanded until the contract is completed to the satisfaction of the parties thereto; Violating any other provision of chapter 142A. Please note the following DATE/TIME/PLACE OF YOUR HEARING: Date: Wednesday, August 17, 2005. Time: 11:00 AM Place: Department of Public Safety McCormick Building One Ashburton Place, Room 1301 Boston, MA 02108 Substantiated violations as determined by the hearing officer may result in suspension or revocation of this registration and/or assessment of an administrative penalty up to $2,000 for each violation. You have the right to be represented by legal counsel at this hearing and present oral testimony and documentary evidence on your behalf. Request for continuances of any scheduled hearing must be made, in writing, and received in this office no later than ten (10) days prior to the scheduled hearing. The request for must include detail reasons for the requested continuance. The matter shall not be deemed continued unless you have received notice from this office granting the continuance. A complete investigatory file is available for review at the Department Public Safety during regular business hours. Failure to appear for this Hearing without approved reason may be cause for immediate suspension or revocation of your Home Improvement Registration and may also result in monetary penalties. Please address any correspondence concerning this matter to the following: Estee Ormont, Program Coordinator Department of Public Safety/BBRS Home Improvement Contractor Registration Program One Ashburton Place, Room 1301 Boston, MA 02108 (617) 727-3200 extension 25225 Very truly yours, Estee Ormont Hearing Clerk ' M Cc: Steven Tryder, Complainant Robert Nicetta, Inspector of Buildings, N. Andover _W Locatiori,?606 No. �6 Date p' 40RT" 1 TOWN OF NORTH ANDOVER + Certificate of Occupancy $ ��SSACNUs c�' Building/Frame Permit Fee Y$ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 17353 / \Building InspeOr ..a - TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING t, , BUILDING PERMIT NUMBER: ^ DATE ISSUED: �-I SIGNATURE: 22LA.11 Building Commissioner or of Buildings Date SECTION 1- SITE INFORMATION z1.1 Property Address: 1.2 Assessors Map and Parcel Number: � Jib t o Q ? �, C ' 60 CRcoo®' Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zonin District Proposed Use Lot sb Fronta e ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1.71Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone 0 Municipal ❑ On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 b r of Record Name (Print) Address for Service: �z-� cgs -z2 Signature Telephone 2.2 Owner of Record: t `Name Print Address for Service: ;4 Si nawre Telephone SECT(ON 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: �-/ Duval Roofing Y P.O. Box 637 License Number Address rjpT01 Reading, MA -- 01864 /, fY 0 Z Expiration Date ` Signature Telephone 3.2 Registered Home Improvement Contractor . Not Applicable 0 V a� ! < �1 Company Name Duval Roo Roofing Registration Number P.O. Box 637 Add Radjulig MA 01 ez // Expiration Dat Sip4ature Telephone V M z O O Z M 90 O Mn r vs r r ^^z V/ W SECTION 4 - WORKERS COMPENSATION (M.G.L. C 152 § 2506) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the buildi rmit. Signed affidavit Attached Yes ....... V No ....... ❑ SECTION 5 Description of Proposed Work check allapplicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: A — SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by pern-iit applicant OFFICIAL USE" ONLY 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (e) X (b) W n. 4 Mechanical (HVAC)�t 5 Fire Protection 6 Total 1+2+3+4+5Cocoa Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT ORICONTRACTOR APPLIES FOR BUILDING PERMIT � 1, Slr t)r�y /� - / yd (� as Owner/Authorized Agent of subject property Hereby authorize D JML iQ OO RAJ 6 to act on My beh ' n all matters re ive to orized by this building pennit application. d Signature of Owner Date SECTION 7b OWNERJAUTHOR!4RD AGENT DECLARATION 1, as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and Jbelief Pri e Si r ture of Owner/Agent Date RUMPE NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 s 2ND 3RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DtIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BU9,DING ON SOLID OR FILLED LAND 1S BUILDING CONNECTED TO NATURAL GAS LINE North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM in accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11,S150A. The debris will be disposed of in: of Facility S iqqature of Permi cant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Name Please Print I City T ' Phone # I am a homeowner performing all work myself. 0 $. I am a sole proprietor and have no one working in any capacity I am an employer providingorkers' co pensajon for my employees working on this job. 63 �245-5 X16 7�ej)ce�3�-Yc-) Company name: Address City: Phone #: Insurance Co. Policy # Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of.a fine up to $1,500.00 and/or one years' imprisonment asmelLas_civil,penattiesin theformof-a._STOP WORK.ORDER..and_a.fine.of.(.$1.0.0.00)_a day-against.me. understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify S ,e pains and penalties of perjury that the information provided above is true and correct. Date /� 1-7 Print name ti.-l� c1sc Phone # Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensing Building Dept OCheck if immediate response is required 0 Licensing Board E] Selectman's Office Contact person: Phone #: ❑ Health Department F1 Other e m m m m y m y mm 5 0 z 0 ND O d CO) Cl) CD PCZ Z y CD CL r O Q� CL ca O y �® O CD CD O CL c� =r Wd CD CD o CD C. CD y n0 ti C O CO) O 1 CD O � CD O CCD WWI 0 O Z O 2r a 0 a to O w C CO cod m s 0 N O C N COD = sCOD o �•® a CO o o Cl) y m !t No �. = of 0:1 7 co.•r a o m Ti �00� O COD g =r aCD GO �. o = ; z:5. °' O H n ' m: a• a a H = ' O S m O N ' ' CL m�. d y . a s ; 0' CL p) C fS �C ® co) N � mq CD c -i: a. a H .•r •o o : R m r. om� C C H . ,►� CD m Wim: mm: a� n� - 0 0; a �a c o n = a CD fD � lr ^ V �' jtC%7' r� ��f1 � a• 0 a 0 Z, bd r ��•%•1 n �' y R °o 7°��' L• (1 O 0 n 0 � v z 00 e � NOTICE TO EMPLOYEES �L I NOTICE TO EMPLOYEES The Commonwealth of Massachusetts DEPARTMENT OF INDUSTRIAL ACCIDENTS 600 Washington Street, Boston, Massachusetts 02111 617-727-4900 — http://www.mass.gov/dia As required by Massachusetts General Law, Chapter 152, Sections 21, 22 & 30, this will give you notice that I (we) have provided for payment to our injured employees under the above mentioned chapter by insuring with: THE TRAVELERS INSURANCE COMPANIES NAME OF INSURANCE COMPANY ONE TOWER SQUARE HARTFORD CT 06183 ADDRESS OF INSURANCE COMPANY (7PJUB-73OK535-4-04 POLICY NUMBER ARGEROS INS AGCY INC 360 MAIN STREET READING NAME OF INSURANCE AGENT ADDRESS DUVAL, KENNETH P DBA DUVAL ROOFING 02-17-04 TO 02-17-05 EFFECTIVE DATES MA 01 867 184 PARK STREET NORTH READING MA 01864 EMPLOYER ADDRESS PHONE # EMPLOYER'S WORKERS COMPENSATION OFFICER (IF ANY) DATE MEDICAL TREATMENT The above named insurer is required in cases of personal injuries arising out of and in the course of employment to furnish adequate and reasonable hospital and medical services in accordance with the provisions of the Workers' Compensation Act. A copy of the First Report of Injury must be given to the injured employee. The employee may select his or her own physician. The reasonable cost of the services provided by the treating physician will be paid by the insurer, if the treatment is necessary and reasonably connected to the work related injury. In cases requiring hospital attention, employees are hereby notified that the insurer has arranged for such attention at the NAME OF HOSPITAL ADDRESS 006208 W20P1G02 TO BE POSTED BY EMPLOYER rte I ✓�ce U�a7xyxryn�,�/� ..�2aa�ezr,/,ua BOARD OF BUILDIN REGULATIONS \ LiceBset CONSTRUCTION SUPERVISOR l Number CS 0$8443 i Birthdate 12/1:Q(1°966 Expires 12/10120Q5 Tr. no: 10052 KENNETH? PO'BOX 190/72 NORTH ST N READING, MA 018(14 Administrator �. _ __ ✓/ie Uoinrno�z�oeal wj Board of Building Regusations.and Standards HOME PAJOROVEMENT CONTRACTOR RegiStFateon 1;'09288 DUVAL ROOI=1NGti . Kfe lneth Duva! F 1'U BOX 190172 NuRTrl-STt `J N. Rt:ADINGI, NIA -- 1 To Reorde+Cal FB_sW, tinting service 1-60D-625-6532 Woburn, MA 01601 i 17-b �q Ref. No: G 15221192 I AECe 1e- - A- T-- --lu a uvc ui ices. suec1T1cannnc x& Page No. of Pages Builders License # 58443 g �I Home Construction Reg. # 109288 DUVAL ROOFING CertainTeed/Certification # 1911 ANT\10 P.O. Box 637 GAF Certified Master Elite - ����� No. Reading, Massachusetts 01864 (781) 944.1994 • (9'�8) 664-2557 STREET Q f TE J /s y► CITY, STAT ND ZIP C E �P/ JOB LOCATION ARCHITECT DATE OF PLANS JOB PHONE We hereby submit specifications and estimates for: Optional- (Not included in price) �a Recommended �tl trP -- -- ---- Jt_Od { (Included in price) Rip & Remove all shingles debris from roof & lob site el flayer E) 2 layers ❑ 3 layers or more m l Repair/ or Replace any roof decking, if -needed; not to exceed 50 sq ft. „ Install 8" aluminum di edge and rake edge over entire perimeter. Choice of mill, white or brown _ — - _ 'a Install ICE &:WATER-:underlaymen# Installed uhder lower courses of shingles as a water tight shield between roof - deck and shingles, self-sealing around nails and deck joints for maximum protection / W R Grace or GAF Weather Max 7 _ _.__� #30 Atlas- Premium Asphalt -base underlayment or GAF Shingle Mate ------- Installeholee of 25 CertainTeed, GAF or Tamko roof shingles, traditional 3 • _._.. 5 year _. ^�. �� -tab ❑30 year tall V-/' Install choice -of 30 year CertainTeed GAF or Tamko Architectural shingles] random - shake 040 ear ❑60 yea � � r� Install new vent .pipeFflange(s)- ..____tall. • Chimney - Rip & Remove old,lead flashing install new leadflashing t4 ChimneyRe-step existing flashing counter flash if necessary - p 9 Wr Install Cobra 40 -year / shingle• ridge -vent --- -- � • Install soffit -ventilation -- • Seamless aluminum gutters -- tall. • Aluminum i - downspouts ,,56 Other Price includes all items above that are checked only / others may be priced separately upon re uest:. _ --_ *Please Note: All items in roof attic should be removed or covered due to falling roof particles,: at time of roof tear -off e ru usE hereby to fur-nis.h material and_I'abor-- complete in-accordancawith above specifications, for the sum of: 7 0 Total rice not including .o tions. dollars (s, j i % Payment to be made as follows:J. 30% deposit required before ordering materials. Balance due in full upon da of completion. Please make all payments out to Kenneth.Duval, mailed to: P.O. Box 637, No. Reading, MA 01864 _ ' . Authorized Signature is Note: This proposal may be withdrawn by us if not -accepted within days. /� intTri, of ril"nIXT4 \ I I AECe 1e- - A- T-- --lu a uvc ui ices. suec1T1cannnc